Pengaruh Pemberian Inhalasi Budesonid/Formoterol Fumarat Dibandingkan Dengan Flutikason Propionat/Salmeterol Xinafoat pada Rehospitalisasi Pasien PPOK di RS Paru Respira
Eni Yulianti(1*), Probosuseno Probosuseno(2), Zullies Ikawati(3)
(1) Universitas Gadjah Mada
(2) Fakultas Kedokteran, Kesehatan Masyarakat dan Keperawatan Universitas Gadjah Mada/Rumah Sakit Umum Pusat Dr. Sardjito, Yogyakarta
(3) Departemen Farmakologi dan Farmasi Klinik, Fakultas Farmasi, Universitas Gadjah Mada
(*) Corresponding Author
Abstract
Pencegahan rehospitalisasi terkait PPOK merupakan prioritas di dunia untuk memperlambat progresi penyakit. Pengontrol gejala PPOK yaitu kombinasi ICS/LABA sering digunakan, diantaranya adalah inhalasi budesonid/formoterol fumarat dan flutikason propionat/salmeterol xinafoat. Tujuan penelitian ini adalah mengetahui pengaruh pemberian inhalasi budesonid/formoterol fumarat terhadap kejadian rehospitalisasi pasien terkait PPOK dalam 6 bulan jika dibandingkan dengan inhalasi flutikason propionat/salmeterol xinafoat. Penelitian observasional dengan desain kohort retrospektif ini mengggunakan sampel data RM pasien post-ranap RS Paru Respira periode KRS 1 Januari 2019-31 Desember 2020. Pengaruh penggunaan kedua obat inhalasi terhadap kejadian rehospitalisasi terkait PPOK dalam 6 bulan setelah KRS dianalisis dengan survival analysis Kaplan-Meier test. Pengaruh variabel perancu terhadap outcome dianalisis dengan Cox Proportional Hazard Model. Pada penelitian diperoleh sebanyak 190 sampel yang terbagi dalam 2 kelompok yaitu kelompok inhalasi Bud/Form (n=95) dan kelompok inhalasi FP/Salm (n=95). Hasil survival analysis menunjukkan persentase yang lebih besar pada inhalasi Bud/Form (87,4%) dibanding pada inhalasi FP/Salm (83,2%) namun tidak berbeda bermakna (p value 0,442). Analisis multivariat dengan melibatkan pengaruh variabel perancu menunjukkan penurunan hazard namun tidak bermakna pada penggunaan inhalasi Bud/Form dibanding FP/Salm (HR 0,689; 95% CI 0,313-1,517; sig. 0,355). Sebagai kesimpulan, persentase ketahanan terhadap rehospitalisasi terkait PPOK dalam 6 bulan pada penggunaan inhalasi budesonid/formoterol fumarat lebih besar dibanding pada penggunaan inhalasi flutikason propionat/salmeterol xinafoat tanpa beda bermakna. Kedua sediaan inhalasi ICS/LABA tersebut tetap dapat direkomendasikan sebagai terapi pengontrol pada pasien dengan PPOK.
Keywords
Full Text:
PDFReferences
1. Tashkin DP, Ohar JA, Koltun A, Allan R, Ward JK. The Role of ICS/LABA Fixed-Dose Combinations in the Treatment of Asthma and COPD: Bioequivalence of a Generic Fluticasone Propionate-Salmeterol Device. Pulm Med. 2021;2021:8881895.
2. Roberts MH, Clerisme-Beaty E, Kozma CM, Paris A, Slaton T, Mapel DW. A retrospective analysis to identify predictors of COPD-related rehospitalization. BMC Pulm Med. 2016;16(1):68.
3. GOLD-2020-POCKET-GUIDE-ver1.0_FINAL-WMV.pdf. Accessed August 25, 2022. https://goldcopd.org/wp-content/uploads/2020/03/GOLD-2020-POCKET-GUIDE-ver1.0_ FINAL-WMV.pdf
4. Lewis A, Torvinen S, Dekhuijzen PNR, et al. The economic burden of asthma and chronic obstructive pulmonary disease and the impact of poor inhalation technique with commonly prescribed dry powder inhalers in three European countries. BMC Health Serv Res. 2016;16:251.
5. Partridge MR, Schuermann W, Beckman O, Persson T, Polanowski T. Effect on lung function and morning activities of budesonide/formoterol versus salmeterol/fluticasone in patients with COPD. Ther Adv Respir Dis. 2009;3(4):147-157.
6. Perrone V, Sangiorgi D, Buda S, Degli Esposti L. Comparative analysis of budesonide/formoterol and fluticasone/salmeterol combinations in COPD patients: findings from a real-world analysis in an Italian setting. Int J Chron Obstruct Pulmon Dis. 2016;11:2749-2755.
7. Tashkin DP. Formoterol for the Treatment of Chronic Obstructive Pulmonary Disease. Int J Chron Obstruct Pulmon Dis. 2020;15:3105-3122.
8. Bai JW, Chen X xin, Liu S, Yu L, Xu JF. Smoking cessation affects the natural history of COPD. Int J Chron Obstruct Pulmon Dis. 2017;12:3323-3328.
9. Westerik JAM, Metting EI, van Boven JFM, Tiersma W, Kocks JWH, Schermer TR. Associations between chronic comorbidity and exacerbation risk in primary care patients with COPD. Respiratory Research. 2017;18(1):31.
10. Ko FW, Chan KP, Hui DS, et al. Acute exacerbation of COPD. Respirology. 2016;21(7):1152-1165.
11. Chen L, Chen S. Prediction of readmission in patients with acute exacerbation of chronic obstructive pulmonary disease within one year after treatment and discharge. BMC Pulmonary Medicine. 2021;21(1):320.
12. Kong CW, Wilkinson TMA. Predicting and preventing hospital readmission for exacerbations of COPD. ERJ Open Research. 2020;6(2).
13. Wu YK, Su WL, Yang MC, Chen SY, Wu CW, Lan CC. Characterization Associated with the Frequent Severe Exacerbator Phenotype in COPD Patients. Int J Chron Obstruct Pulmon Dis. 2021;16:2475-2485.
14. Larsson K, Janson C, Lisspers K, et al. Combination of budesonide/formoterol more effective than fluticasone/salmeterol in preventing exacerbations in chronic obstructive pulmonary disease: the PATHOS study. Journal of Internal Medicine. 2013;273(6):584-594.
15. Blair A, Sathyanarayanan S, Benjamin B. Retrospective, matched cohort study of the effectiveness of common COPD drug treatments on 30-day readmissions. Published online February 22, 2019. Accessed May 27, 2022. https://shareok.org/handle/11244/323882
16. Lu D, Ma J, Yang X. Salmeterol combined with fluticasone propionate improved COPD in patients during stable stage. Int J Clin Exp Med. 2014;7(9):2907-2911.
17. Rinne ST, Graves MC, Bastian LA, et al. Association Between Length of Stay and Readmission for COPD. Am J Manag Care. 2017;23(8):e253-e258.
18. Laue J, Reierth E, Melbye H. When should acute exacerbations of COPD be treated with systemic corticosteroids and antibiotics in primary care: a systematic review of current COPD guidelines. npj Prim Care Resp Med. 2015;25(1):1-8.
19. Fernández-García S, Represas-Represas C, Ruano-Raviña A, et al. Social and clinical predictors of short- and long-term readmission after a severe exacerbation of copd. PLOS ONE. 2020;15(2):e0229257.
20. Roede BM, Bresser P, Prins JM, Schellevis F, Verheij TJM, Bindels PJE. Reduced risk of next exacerbation and mortality associated with antibiotic use in COPD. European Respiratory Journal. 2009;33(2):282-288.
21. Blee J, Roux RK, Gautreaux S, Sherer JT, Garey KW. Dispensing inhalers to patients with chronic obstructive pulmonary disease on hospital discharge: Effects on prescription filling and readmission. American Journal of Health-System Pharmacy. 2015;72(14):1204-1208.
22. Jo YS, Rhee CK, Kim KJ, Yoo KH, Park YB. Risk factors for early readmission after acute exacerbation of chronic obstructive pulmonary disease. Ther Adv Respir Dis. 2020;14:1753466620961688.
DOI: https://doi.org/10.22146/farmaseutik.v19i4.75256
Article Metrics
Abstract views : 1402 | views : 1541Refbacks
- There are currently no refbacks.